Faculty Group Practice Newsletter

CMS created the G0136 to be used for billing the Social Determinants of Health (SDoH) Risk Assessment. 

There are certain rules and documentation requirements surrounding this code.  This code is time based; time must be documented. 

1. The SDoH Risk Assessment IS NOT TO BE USED AS A SCREENING TOOL

   1. The provider must suspect there is a SDoH AND it is interfering with the provider’s treatment plan for the patient. CMS provided this example: The patient has cancelled several of their follow-up appointments at the last minute causing the follow-up visit to be delayed.  The lack of the timely follow-up visit is impacting the treatment plan.  The provider suspects the patient has a transportation challenge.  

2. Required Documentation:
   1. Suspicion of the SDoH circumstance.
   2. Evidence that a standardized nationally recognized questionnaire was used. This often shows the questions and answers in the documentation.
   3. If the questionnaire identifies the SDoH, the relevant resources provided to the patient to assist with the SDoH.
   4. The impact on the treatment plan.
   5. The time spent reviewing the results of the questionnaire. The G0136 is time based, therefore, time reviewing the assessment must be documented.
   6. ICD-10 identifying the SDoH with the Z-Code.

The G0136 may be used as a SCREENING TOOL ONLY when the visit is for the Medicare Annual Wellness Visit.